BRANCH MEDICAL CLINIC NORTH ISLAND (NPI# 1679771133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679771133 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC NORTH ISLAND |
| Practice Address |
34520 Bob Wilson Dr San Diego CA 92134-2098 |
| Mailing Address |
601 Mccain Blvd. Coronado CA 92135 |
| Practice Telephone | 6195326636 |
| Mailing Telephone | 6195454263 |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2019-04-04 |
| Authorized Official Name | MR. WILLIAM MICHAEL CONDON (NAVY MEDICINE UBO PROGRAM MANAGER) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Street Address |
34520 BOB WILSON DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92134-2098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932195567 | Neil Frank Gibbs | Dermatology | 34520 Bob Wilson Dr, Dermatology Department, Naval Medical Center, San Diego, CA 92134-2300 | 2005-09-20 |
| 1578036174 | Michael Matthew Fregolle | Military Health Care Provider | 34520 Bob Wilson Dr, San Diego, CA 92134-2098 | 2019-01-07 |
| 1932677499 | Emily J Thomas | Physician Assistant | 34520 Bob Wilson Dr, San Diego, CA 92134-2098 | 2018-11-02 |
| 1689184624 | Lisa Rene Burns | Nurse Practitioner | 34520 Bob Wilson Dr, San Diego, CA 92134-2098 | 2017-10-04 |
| 1154659803 | Michael William Terrenzi | Pharmacist | 34520 Bob Wilson Dr, Naval Medical Center, Pharmacy Dept. Bldg. 1 Flr. 1, San Diego, CA 92134-2098 | 2009-11-18 |
| 1235367327 | Paula Witherspoon | Pediatrics | 34520 Bob Wilson Dr, Department of Pediatrics, San Diego, CA 92134-2030 | 2009-06-26 |
| 1477780617 | Erin Beth Storie | Dermatology | 34520 Bob Wilson Dr, Suite #300, San Diego, CA 92134-2098 | 2009-06-15 |
| 1164558102 | Alana Sulit | Registered Nurse | 34520 Bob Wilson Dr, San Diego, CA 92134 | 2007-02-26 |
| 1568525319 | Carol Lynn Budzik | General Practice | 34520 Bob Wilson Dr, Suite 100, San Diego, CA 92134-2098 | 2006-12-19 |
| 1104998053 | Mary Jane Hall Willis | Pediatrics | 34520 Bob Wilson Dr, Suite 100, San Diego, CA 92134-2098 | 2006-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| 1508495201 | Benjamin Michael Taylor | Military Health Care Provider | Naval Medical Center San Diego Psychiatry Residency Pgm, 34800 Bob Wilson Drive, San Diego, CA 92134 | 2020-04-04 |
| 1255870333 | Dosh Page | Physician Assistant | Swmi Farenholt Avenue, Building 14, San Diego, CA 92134 | 2017-02-22 |
| 1417328063 | Noem Clay Gallego | Military Health Care Provider | 34101 Building 14, Farenholt Avenue, San Diego, CA 92134 | 2015-10-08 |
| 1972999183 | Justin Paul Lachney | Military Health Care Provider | 34101 Farenholt Avenue, San Diego, CA 92134 | 2015-04-14 |
| 1174963532 | Ryan Anders Crane | Otolaryngology | Department of Otolaryngology - Nmc San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 | 2013-07-01 |
| 1447591268 | Amy B. Cornell | Student in an Organized Health Care Education/Training Program | 34800 Bob Wilson Drive, San Diego, Ca, Apo, AA 92134 | 2013-03-04 |
| 1841562956 | Christopher Patrick Androski Jr. | Emergency Medical Technician, Basic | Naval Medical Center San Diego 38400 Bob Wilson Dr, San Diego, CA 92134 | 2012-02-04 |
| 1164717740 | Jason James Weiner | Internal Medicine | Dept of Internal Medicine, Division of Rheumatology, 34800 Bob Wilson Drive, San Diego, CA 92134 | 2011-06-13 |
| 1225320237 | Kimberly Ann Thompson | Student in an Organized Health Care Education/Training Program | Navy Medical Center San Diego Gme Department, 34800 Bob Wilson Dr., San Diego, CA 92134 | 2011-05-09 |
| Find all providers in zip 92134 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023400256 | Branch Medical Clinic Mcas Miramar | Clinic/Center | Bauer Rd, Bldg 2496, San Diego, CA 92145-0001 | 2015-02-25 |
| 1003006628 | Branch Medical Clinic Naval Station San Diego | Clinic/Center | 2450 Craven Steet, San Diego, CA 92136-5599 | 2007-07-30 |
| 1730386327 | Branch Medical Clinic Ntc San Diego | Clinic/Center | 2051 Cushing Road, Bldg 624, San Diego, CA 92106-0000 | 2007-06-28 |
| 1104962448 | U.S. Coast Guard | Clinic/Center | 2734 Belknap Way, San Diego, CA 92106-6401 | 2007-01-30 |
| 1932502788 | Branch Medical Clinic Rancho Bernardo | Clinic/Center | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2014-10-07 |
| 1538480298 | Us Coast Guard | Clinic/Center | 2051 Cushing Road, Us Coast Guard, San Diego, CA 92106 | 2010-06-17 |
| 1649446857 | Branch Medical Clinic Mcrd | Clinic/Center | 35000 Guadalcanal St, Branch Medical Clinic Mcrd, San Diego, CA 92140 | 2008-05-07 |
| 1225220270 | Branch Medical Clinic Coronado | Clinic/Center | 601 Mccain Blvd, Naval Base Coronado, San Diego, CA 92135-7046 | 2007-08-14 |
| 1922206853 | Tricare Outpatient Clinic Clairemont | Clinic/Center | 8808 Balboa Ave, San Diego, CA 92123-1592 | 2007-07-03 |
| 1588728497 | Naval Medical Center San Diego | Clinic/Center | Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134-5000 | 2006-12-22 |
| Find all providers in SAN DIEGO | ||||
Please comment or provide details below to improve the information on BRANCH MEDICAL CLINIC NORTH ISLAND.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.